临床诊断巨脾型晚期血吸虫病的病理病原检查和随访观察

A CLINICAL AND PATHOLOGICAL STUDY ON PATIENTS WITH SPLENOMEGALIC ADVANCED SCHISTOSOMIASIS

本文报告２２１例临床诊断为巨脾型晚期血吸虫病（晚血）患者肝组织病理检查结果，其中单纯血吸虫性肝纤维化１３１例（５９．３％），血吸虫性肝纤维化合并肝炎（伴肝细胞变性、坏死）４２例（１９．０％），肝炎肝硬化２７例（１２．２％），慢性肝炎１３例（５．９％），其它疾病８例（３．６％），表明肝炎及肝炎肝硬化是误诊为晚血的主要疾病。随访２～７年１７７例，死亡２９例，病死率１６．４％，肝炎肝硬化及血吸虫肝纤维化伴肝细胞病变者病死率均显著高于单纯血吸虫肝纤维化患者（Ｐ＜０．０５），多数患者死于肝衰竭及原发性肝癌。死于上述肝病者均存在ＨＢＶ和／或ＨＣＶ感染，提示ＨＢＶ及ＨＣＶ感染是晚血发生肝衰竭及肝癌的关键因素，与患者死亡密切相关。

Liver biopsy and serological tests for HBV and HCV markers were done on patients with clinical diagnosis of splenomegalic advanced schistosomiasis(AS). The clinical outcome of the patients was followed up for 2 to 7 years. According to the histological findings, 131 out of 221 patients(59.3%) were diagnosed as schistosomiasis with liver fibrosis(SLF). 42( 19. 0%) were SLF accompanied chronic hepatitis, 27(12.2%) were hepatitis cirrhosis and 13(5.9%) were chronic hepatitis. The positive rate of HBV DNA(PCR) and/or HCV RNA(PCR) among the patients with SLF accompanied by chronic hepatitis was 96.7%. The results suggested that the hepatocellular lesions were closely related to HBV and HCV infections. One hundred and seventy seven patients were followed up. Twenty nine patients died. The mortality of the patients with SLF( 10%) was lower than that of patients with SLF accompanied with chronic hepatitis(27.8%) and patients with hepatitis cirrhosis(43.8%, P<0.05). The most common cause of death was hepatic failure(12 cases) . The second cause was hepatocellular carcinoma(5 cases). All of these patients were positive for HBV and/or HCV markers. HBV and HCV infections may play a crucial role in accurence of hepatic failure, hepatocellular carcinoma and death of patients with AS.